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PubMedDate not supplied

The development of a benchmarking system for a cancer patient population.

Benchmarking, while a useful way to compare outcomes among health care institutions, has been less useful for institutions dealing with specialty patient populations such as cancer, rehabilitation, or psychiatry. Because of regulatory requirements mandating the use of benchmarking for accreditation and performance improvement purposes, a group of comprehensive cancer centers developed a specialized database for benchmarking outcomes for cancer patients. This article describes the development of the database and some of the obstacles encountered by the group. It also outlines solutions to the obstacles. Key words: benchmarking, cancer, quality

Benchmarking↗
PubMed1998

Using videotaped benchmarks to improve the self-assessment ability of family practice residents.

PURPOSE: To address methodologic and statistical problems of previous studies of self-assessment by exposing participants to relevant standards, anchoring rating scales, and providing practice in the use of the assessment tool. METHOD: Fifty first- and second-year family practice residents performed a ten-minute patient interview with a difficult communication problem. Following each interview, the resident and two experts independently evaluated the resident's communication skills. The resident was then shown a videotape of four performances (ranging in quality from poor to good) of the same scenario. The resident evaluated the communication skills displayed in each performance and then reevaluated his or her own performance. RESULTS: The correlation between experts' evaluations and residents' self-evaluations was moderate immediately after the interview (r = 0.38) but increased significantly after the residents viewed the videotape (r = 0.52). This effect was more pronounced for first-year residents (0.22 to 0.45) than for second-year residents (0.53 to 0.65), although the difference was not significant. Post-hoc analysis revealed that neither initial nor post-benchmark self-assessment ability was related to the ability to accurately evaluate the benchmarks in a manner consistent with the experts. CONCLUSIONS: The ability to self-assess does not seem strongly tied to the ability to assess the performances of others on the same task. Nonetheless, providing a set of benchmarks against which trainees can compare their own performances improves their ability to self-evaluate even if the qualities of the benchmarks are not explicitly identified.

Adult↗
PubMedDate not supplied

The 1999 National Pressure Ulcer Prevalence Survey: a benchmarking approach.

OBJECTIVE: Health care professionals are faced with the ongoing challenge of improving performance. From physicians and nurses to process improvement experts, health care professionals are discovering new approaches to increasing the overall effectiveness of procedures used in clinical areas. One way to collect data useful for benchmarking specific clinical practices is through the use of prevalence studies. DESIGN: A 1-day pressure ulcer prevalence survey was performed in March 1999. Acute care facilities across the United States volunteered to participate in the data collection process. Patients' demographic information, pressure ulcer stages, locations, and support surfaces were noted. SETTING: 356 acute care facilities. PARTICIPANTS: 42,817 patients. RESULTS: The overall pressure ulcer prevalence was 14.8%, with a nosocomial pressure ulcer prevalence of 7.1%. CONCLUSIONS: Benchmarking is one of the tools that enables health care professionals to measure and identify inconsistencies in patient care practices. Understanding these inconsistencies enables the health care team to develop processes that are innovative and efficient. National pressure ulcer prevalence surveys provide a benchmark to evaluate an individual facility's care and treatment of patients at risk for pressure ulcer development. Success, however, lies in the health care professional's ability to take the information and apply it to clinical practice. Through the use of a benchmarking approach, performance gaps can be identified, processes can be put into place, and improved patient outcomes can be monitored and maintained.

Adolescent↗
PubMed2001

The ICCD benchmarks for clubhouses: a practical approach to quality improvement in psychiatric rehabilitation.

OBJECTIVE: The study evaluated whether the average performance of clubhouses certified by the International Center for Clubhouse Development (ICCD) should be considered valid benchmarks for clubhouse programs. METHODS: A representative sample of clubhouses more than three years old that were based on the Fountain House model participated in a 1998 mail survey. To verify that ICCD certification is a valid indicator of program quality for use in setting benchmark performance rates, 71 certified and 48 noncertified programs were compared on a variety of organizational variables. RESULTS: Even though certified and noncertified clubhouses were similar in organizational structure and resources, findings from a logistic regression analysis confirmed that certified clubhouses provided a wider array of rehabilitation services and achieved higher rates of employment. CONCLUSIONS: The findings suggest that ICCD certification is a valid indicator of program quality. The ICCD has therefore proposed that the average performance of certified U.S. clubhouses in specific domains be adopted as benchmarks for organizational performance. When tailored for programs in particular regions and with specific levels of funding, the ICCD benchmarks for clubhouse performance set fair and reasonable expectations for clubhouse programs and for the design of performance contracts between departments of mental health and ICCD clubhouses.

Benchmarking↗
PubMed2003

Toward benchmarks for tertiary care for adults with severe and persistent mental disorders.

BACKGROUND: Scarce attention has been paid to establishing benchmarks for tertiary care for adults with severe mental disorders. Yet, the availability and efficient utilization of residential resources partly determines the capacity of a comprehensive system of care to avoid clogging ever-shrinking acute care bed facilities. OBJECTIVES: To describe the actual utilization of and projected needs for residential resources, one part of tertiary care, in the catchment area of a psychiatric hospital in east-end Montreal. To compare results obtained against actual utilization and projected needs evaluated in other Canadian provinces and in other countries, with a view to establishing national benchmarks. METHODS: Two surveys were undertaken to establish the number of places in these facilities that were utilized and needed for adults aged 18 to 65 years with severe mental disorders, without a primary diagnosis of mental retardation or organic brain syndrome, and originally from the catchment area. A first survey ascertained the number of places utilized and of those needed for residential care among all long-stay inpatients and all adults in supervised residential facilities. A second survey identified the need for such long-stay hospitalization, nursing homes, and supervised facilities as an alternative or as a complement to hospitalization among acute care inpatients. RESULTS: The actual ratio of places in long-stay hospital units, nursing homes, and supervised residential facilities was 150:100,000 inhabitants. The ideal ratio, according to estimated needs, is 171:100,000. The figure breakdown is as follows: 20:100,000 for long-stay hospital units, 20:100,000 for nursing homes, 40:100,000 for group homes, 40:100,000 for private hostels or foster families, and 51:100,000 for supervised apartments. The needs of this urban, blue-collar population for supervised residential places hovered in the upper range of utilization and standards for European countries and within the proposed standards for Canadian provinces. DISCUSSION: Needs for long-stay hospitalization or for supervised residential facilities cannot be treated as absolute. For example, evaluation conducted in this hospital-led system of psychiatric care may produce higher estimates of institutional care. Comparing actual utilization and projected needs in this urban catchment area with current utilization in other jurisdictions in Canada and Europe should contribute to establishing sound national benchmarks within ranges. CONCLUSIONS: It is possible to establish benchmarks that guide the development of supervised residential settings to best meet the needs of the population of adults with severe and persistent mental disorders. The methods used here to assess needs should serve as guidelines for future research, because they were designed to contain the bias of over- or underprovision of care in the current utilization.

Adolescent↗
PubMedDate not supplied

Benchmarking implementation of a computerized system for long-term care.

The purpose of this study was to apply a benchmarking methodology to identify the most effective approaches used by long-term care facilities in implementing new computerized resident assessment instrument/minimum data set (RAI/MDS) systems and to develop implementation protocols based on these "best practices." Site visits were conducted with 3 long-term care facilities, selected on the basis of a national search. Facility directors, directors of nursing, information system managers, and frontline staff at each facility were targeted, and questionnaires were developed for each to assess factors viewed as important to successful implementation. A convergence was found in recommended action steps reported across sites to facilitate introduction and implementation of new RAI/MDS software. An example of how benchmarking results were used to develop an implementation plan is provided. Benchmarking provided a useful methodology for identifying best practices to guide implementation planing for adoption of a new computerized RAI/MDS system in the current trial. The benchmarking steps described are replicable and can be used to guide implementation of other new systems in the nursing home setting.

Benchmarking↗
PubMed2001

Benchmarking can facilitate the sharing of information on outcomes of care.

Recent restructuring in the national health service (NHS) aimed to effect cultural and organisation changes that would ensure fair and equal access for service users to effective and efficient services. Clinical governance has been introduced as a means of delivering quality improvement. One element of this is the use of benchmarking to assess current process and outcome and to use comparative information to inform about current and best practice. The use of the Therapy Outcome Measure (TOM) (Enderby and John 1997) was investigated as an indicator to benchmark the outcomes of treatment for different client-groups and compare patterns of outcomes from different speech and language therapy (SLT) services. The study recruited eight SLT trust sites and ran for eighteen months. The TOM data was analysed to note similarities and differences in cases entering treatment, in the direction of change resulting from treatment, and on completing treatment. Variation was found on these points between cases with different disorders and across the trusts. TOM data could be used to provide a benchmark for a disorder against which services could make comparisons. However, for benchmarking to succeed there is a need for support and commitment from every level of an organisation.

Benchmarking↗
PubMed1998

Clinical buy-in is key to benchmarking success.

The effectiveness of benchmarking as a tool for improving the quality of healthcare services and reducing costs depends on the completeness of the data and physician acceptance of the findings. Benchmarking analyses based on cost-center data, for example, do not account for many of the actual costs of performing a procedure and, therefore, may be of limited value. Benchmarking studies should use data that provide a complete, detailed picture of what each procedure entails to facilitate consistent comparisons among actual physician practices so that physicians can see clearly how their practices relate to best practices. The current procedural terminology (CPT) coding system can provide an excellent basis for assembling benchmark data.

Abstracting and Indexing↗
PubMed2000

Benchmarks of fairness for health care reform: a policy tool for developing countries.

Teams of collaborators from Colombia, Mexico, Pakistan, and Thailand have adapted a policy tool originally developed for evaluating health insurance reforms in the United States into "benchmarks of fairness" for assessing health system reform in developing countries. We describe briefly the history of the benchmark approach, the tool itself, and the uses to which it may be put. Fairness is a wide term that includes exposure to risk factors, access to all forms of care, and to financing. It also includes efficiency of management and resource allocation, accountability, and patient and provider autonomy. The benchmarks standardize the criteria for fairness. Reforms are then evaluated by scoring according to the degree to which they improve the situation, i.e. on a scale of -5 to 5, with zero representing the status quo. The object is to promote discussion about fairness across the disciplinary divisions that keep policy analysts and the public from understanding how trade-offs between different effects of reforms can affect the overall fairness of the reform. The benchmarks can be used at both national and provincial or district levels, and we describe plans for such uses in the collaborating sites. A striking feature of the adaptation process is that there was wide agreement on this ethical framework among the collaborating sites despite their large historical, political and cultural differences.

Benchmarking↗
PubMed2000

Can benchmarking be applied to radiation protection? And is it useful?

PURPOSE: Any program of protection from the ionizing radiations used for health care must ultimately lead to the total prevention of graduated effects and to the limitation of probabilistic effects to acceptable levels. The latter are the more dangerous because they may occur even at very low doses and involve the whole population including unexposed subjects; these effects may appear in the generations to come. The specific protection of the health of operators, patients, and the general population, depends on a series of physical-technical and bureaucratic-administrative factors. These must be known and applied based on precise reference standards, recommended or stated by law, as well as on appropriately regulated and controlled procedures. We chose to apply the benchmarking method to radiation protection in order to standardize and increase the efficacy of prevention and to plan, according to Deming's cycle, the continuous improvement of radiation protection performance. METHOD: Benchmarking is a qualitative intercomparison method widely used in business economics to improve performance referring to best practice and the best in class. When applied in a department where all the partners belong (internal benchmarking), the method features a subdivision into different (sub)processes integrated according to the logic of problem-solving. These stages are: planning: 1) identifying benchmarking issues; 2) identifying the participants; 3) deciding the data collection method; 4) data collection; analysis: 5) measuring the gap; 6) planning future performance; integration: 7) reporting the results; 8) setting the functional goals; action: 9) developing and implementing plans; 10) checking results and resetting the target. The gross subdivision of resources into human and structural permits to check the gap between an actual and an ideal setting separately. Thus, the procedures will give information on the human factor which will be periodically checked in loco relative to all active and passive conducts, while standards will be used to assess the available spaces, facilities and equipment, as well as the relative regular activity. Specific physical-technical and bureaucratic-administrative indices will be needed in both cases. RESULTS AND DISCUSSION: Solving the operators' doubts and consequently decreasing the statistical errors and/or the cases of incorrect performance has resulted in improved rendered quality, which will be further increased after the planned replacement of substandard or unsafe equipment. Meanwhile, the early application of equipment quality controls has helped rationalize and markedly decrease maintenance costs, which results in possible technologic investment to improve emergency imaging. Greater attention to their protection has made patients feel an improvement in received quality and has increased empathy in general. Total quality, as compared with the best practice, has increased thanks to the positive stimulus from standardization, emulation and sharing, and not only to the controls performed. It is difficult to evaluate the management indices, especially the performance efficacy, that is the relationship between radiation protection and results, because the work is in progress and we still lack the actual data on the decrease in accidents at work or occupational diseases of the operators. Moreover, the epidemiological data on radiation-induced conditions will be difficult to collect and interpret, which will make the dynamics of lawsuits for unwarranted or excessive exposure a useful and more readily available piece of information. Finally, relative to economic results, we would like to stress that no additional costs have been necessary to implement safety and quality in a setting involving, directly or indirectly, thousands of people. (ABSTRACT TRUNCATED)

Algorithms↗
PubMed2001

Benchmark guideline for urinary 1-hydroxypyrene as biomarker of occupational exposure to polycyclic aromatic hydrocarbons.

Many individual polycyclic aromatic hydrocarbons (PAH) are genotoxic carcinogens. One of the parent PAH, pyrene, undergoes simple metabolism to 1-hydroxypyrene. 1-Hydroxypyrene and its glucuronide are excreted in urine. Biological monitoring of exposure to PAH has rapidly been expanded since urinary 1-hydroxypyrene was suggested as a biological index of dose of pyrene. Since pyrene is always present in PAH mixtures, the biological indicator is not only an indicator of uptake of pyrene, but also an indirect indicator of all PAH. At present, several hundreds of papers reporting on urinary concentrations of 1-hydroxypyrene in workers' urine are available. It appeared that urinary 1-hydroxypyrene is a sound biomarker and that the analytical method is robust and non-laborious. Since epidemiological studies of cancer mortality related to long-term average urinary 1-hydroxypyrene concentration are lacking, a sound health-based limit value of 1-hydroxypyrene in urine cannot be set as yet. Since PAH exposure is widespread and the dermal uptake is substantial among exposed workers, an attempt was made to propose a three-level benchmark guideline for urinary 1-hydroxypyrene. The reference value as a 95th percentile in non-occupational exposed controls is 0.24 micromol mol(-1) creatinine and 0.76 micromol mol(-1) creatinine for non-smokers and smokers, respectively. This is the first level of the benchmark guideline. A no-biological-effect-level of 1-hydroxypyrene in urine of exposed workers was found at 1.4 micromol mol(-1) creatinine. It is the lowest reported level at which no genotoxic effects were found and therefore the estimate for the second level of the benchmark guideline. In two types of industry, coke ovens and primary aluminium production, the regression of airborne PAH concentrations and urinary 1-hydroxypyrene concentrations in exposed workers has been studied. The correlation of airborne concentrations and urinary 1-hydroxypyrene in urine of workers from coke ovens and in the primary aluminium industry was used to estimate the level of urinary 1-hydroxypyrene equal to the present occupational exposure limit (OEL) of PAH. The concentration of 1-hydroxypyrene in urine equal to the OEL is 2.3 micromol mol(-1) creatinine and 4.9 micromol mol(-1) creatinine, respectively, in these two industries. These latter values present the third level of the benchmark guideline.

Benchmarking↗
PubMedDate not supplied

How benchmarking can improve patient nutrition.

Benchmarking is a tool that originated in business to enable organisations to compare their services with industry-wide best practice. Early last year the Department of Health published The Essence of Care, a benchmarking toolkit adapted for use in health care. It focuses on eight elements of care that are crucial to patients' experiences. Nurses and other health care professionals at a London NHS trust have begun a trust-wide benchmarking project. The aim is to improve patients' experiences of health care by sharing and comparing information, and by identifying examples of good practice and areas for improvement. The project began with two of the eight elements of The Essence of Care, with the intention of covering the rest later. This article describes the benchmarking process for nutrition and some of the consequent improvements in care.

Benchmarking↗
PubMedDate not supplied

Benchmarking mental health care in a general hospital.

Benchmarking is a tool that allows practitioners to compare and measure their own performance against best practice. Two trusts took a joint approach to benchmarking mental health in a general hospital. They set up a benchmarking comparison group, whose members explored the six elements of the mental health benchmark and identified examples of best practice. The group then scored practice and compared scores. Finally, guidance sheets were produced on assessing and planning care in a general hospital for people with mental health needs. These are included as part of a mental health resource pack for each clinical area in the general hospital.

Benchmarking↗
PubMed1997

[Benchmarks for surgical gynecology: results of the German Society of Gynecology and Obstetrics Quality Assurance Study].

Profiling of performance and quality in gynecological surgery is discussed. Unfortunately, most report cards miss valid clinical benchmarks. Within the German study on quality assurance in gynecological surgery we explored whether indicators of quality were suitable as clinical benchmarks. Using a factor analytic approach, we reduced the number of indicators and obtained in a set of 13 indicators of clinical quality. On the basis of the study data on post operative infections we show that these indicators are suitable as clinical benchmarks: the clinical benchmarks are able to make health care quality transparent and demonstrate opportunities for improvement of the processes of gynecological care.

Benchmarking↗
PubMed1994

Benchmarking of the CAP-88 and GENII computer codes using 1990 and 1991 monitored atmospheric releases from the Idaho National Engineering Laboratory.

The CAP-88 environmental radiological assessment computer code was benchmark tested to establish confidence in its results. The results from CAP-88 were compared to the results from the GENII computer code, which has undergone rigorous testing. The codes were benchmarked using 1990 and 1991 monitored atmospheric releases from Idaho National Engineering Laboratory facilities and the results (the effective dose equivalent to the maximally exposed offsite individual) were quantitatively compared using a metric based on the uncertainty in the Gaussian plume model and terrestrial transport models. The results of the benchmark tests were within the 95% acceptance region specified in the test protocol. CAP-88 was found to overpredict effective dose equivalent relative to GENII for elevated releases, largely because CAP-88 calculates a larger atmospheric dispersion factor (chi/Q) than does GENII using the same meteorological data. However, CAP-88 consistently underpredicted effective dose equivalent relative to GENII for ground-level releases. This was because CAP-88 accounts for the processes of plume depletion by dry and wet deposition while GENII does not account for these processes. The effect of depletion was tested and found to be most important for a ground-level release of a highly depositing species such as radioiodine which implies that acceptable benchmark results would be difficult to obtain for a highly dopositing species.

Computer Simulation↗
PubMed1998

Characterizing dose-response: I: Critical assessment of the benchmark dose concept.

We present a critical assessment of the benchmark dose (BMD) method introduced by Crump as an alternative method for setting a characteristic dose level for toxicant risk assessment. The no-observed-adverse-effect-level (NOAEL) method has been criticized because it does not use all of the data and because the characteristic dose level obtained depends on the dose levels and the statistical precision (sample sizes) of the study design. Defining the BMD in terms of a confidence bound on a point estimate results in a characteristic dose that also varies with the statistical precision and still depends on the study dose levels. Indiscriminate choice of benchmark response level may result in a BMD that reflects little about the dose-response behavior available from using all of the data. Another concern is that the definition of the BMD for the quantal response case is different for the continuous response case. Specifically, defining the BMD for continuous data using a ratio of increased effect divided by the background response results in an arbitrary dependence on the natural background for the endpoint being studied, making comparison among endpoints less meaningful and standards more arbitrary. We define a modified benchmark dose as a point estimate using the ratio of increased effect divided by the full adverse response range which enables consistent placement of the benchmark response level and provides a BMD with a more consistent relationship to the dose-response curve shape.

Animals↗
PubMed2000

Modification and benchmarking of MCNP for low-energy tungsten spectra.

The MCNP Monte Carlo radiation transport code was modified for diagnostic medical physics applications. In particular, the modified code was thoroughly benchmarked for the production of polychromatic tungsten x-ray spectra in the 30-150 kV range. Validating the modified code for coupled electron-photon transport with benchmark spectra was supplemented with independent electron-only and photon-only transport benchmarks. Major revisions to the code included the proper treatment of characteristic K x-ray production and scoring, new impact ionization cross sections, and new bremsstrahlung cross sections. Minor revisions included updated photon cross sections, electron-electron bremsstrahlung production, and K x-ray yield. The modified MCNP code is benchmarked to electron backscatter factors, x-ray spectra production, and primary and scatter photon transport.

Algorithms↗
PubMed1996

Using a benchmarking system to improve patient care and assist in technology assessment.

Clinical benchmarking is a tool of CQI that can be used to improve outcomes in areas of strategic importance. While it is a simple tool, benchmarking requires a long-term commitment from the entire organization involved in its use to be successful. Benchmarking is a means of setting goals or targets. As a tool used for continuous quality management, benchmarking is an ongoing activity of comparing an organization's service, product, or process with similar ones outside the organization that are known to be the best. In attempting to emulate or surpass "best practice," an organization must set challenging but attainable goals and reach them with a plan of realistic and efficient actions.

Critical Pathways↗